New evidence on learning trajectories in a low-income setting.

Using a unique longitudinal dataset collected from primary school students in Pakistan, we document four new facts about learning in low-income countries. First, children's test scores increase by 1.19 SD between Grades 3 and 6. Second, going to school is associated with greater learning. Children who dropout have the same test score gains prior to dropping out as those who do not but experience no improvements after dropping out. Third, there is significant variation in test score gains across students, but test scores converge over the primary schooling years. Students with initially low test scores gain more than those with initially high scores, even after accounting for mean reversion. Fourth, conditional on past test scores, household characteristics explain little of the variation in learning. In order to reconcile our findings with the literature, we introduce the concept of "fragile learning," where progression may be followed by stagnation or reversals. We discuss the implications of these results for several ongoing debates in the literature on education from Low- and Middle-Income Countries (LMICs).

The medical competence of health care providers in sub-Saharan Africa: Evidence from 16 127 providers across 11 countries.

Despite a consensus that quality of care is critically deficient in low-income countries, few nationally representative studies provide comparable measures of quality of care across countries. To address this gap, we used nationally representative data from in-person administrations of clinical vignettes to measure the competence of 16 127 health care providers across 11 sub-Saharan African countries. Rather than large variations across countries, we found that 81% of the variation in competence is within countries and the characteristics of health care providers do not explain most of this variation. Professional qualifications-including cadre and education-are only weakly associated with competence: across our sample, one-third of nurses are more competent than the average doctor in the same country and one-quarter of doctors are less competent than the average nurse. Finally, while younger cohorts do tend to be more competent, perhaps reflecting improvements in medical education, it would take 25 decades of turnover to improve care by 10 percentage points, on average, if we were to rely on such improvements alone. These patterns necessitate a fundamentally different approach to health care human resource management, calling into question typical staffing policies based on qualifications and seniority rather than directly measured quality.